Staten Island Advance/Irving SilversteinJust a few months ago, 19-month-old Mariana was not crawling or walking. Now, with twice-weekly physical therapy sessions, she's able to get through a play tunnel on her own. Cheering Mariana on are her brothers David, 4, and Christopher, 8.

STATEN ISLAND, N.Y. — Dr. Jill Kissel smiles as Mariana Crescitelli makes her way through the colorful play tunnel. Just a few months earlier, the task was impossible for the 19-month-old Westerleigh tot.

For children like Mariana, who wasn’t reaching her crawling and walking milestones, the recently opened Leaps and Bounds, PT, in Willowbrook offers a chance to catch up with their peers.

Dr. Kissel, a pediatric physical therapist, opened the practice to cater to families whose children do not qualify for government-funded early intervention (EI) therapies, wanted additional treatment or had an orthopedic injury.

“A lot of people asked ‘where can I go if I don’t get the [EI] services,’” said Dr. Kissel, who also works as an EI contractor for local providers. “There are kids who are not as severely delayed, but would benefit from physical therapy.”

She enjoys having one-on-one time with her young patients whose parents don’t have to worry about taking them to an adult practice for therapy.

During a recent visit to the new office, Mariana, who has low muscle tone and qualifies for EI, worked with Dr. Kissel on activities to strengthen her leg and core muscles.

The toddler enjoyed moving about the space as she practiced walking up graded steps, balanced on an exercise ball to work on core strength, put fake food in a shopping cart causing her to squat down and crawled through the tunnel as brothers David, 4, and Christopher, 8, encouraged her on the other end.

After about three months of twice-weekly physical therapy, Mariana’s family has seen great improvement.

“She is now walking much better and can go up and down stairs with assistance, which she couldn’t do before,” said mom Naomi Crescitelli.

Children seen by pediatric physical therapists usually have developmental delays or medical conditions that affect their movement and ability to do “whatever they should be doing at their age,” explained Sheree York, president of the American Physical Therapy Association’s Section on Pediatrics

Common diagnoses include cerebral palsy, spina bifida and muscular dystrophy. Children with broken bones or those who need special equipment like wheelchairs and walkers may also see physical therapists along with kids who have undergone surgery for amputations, organ transplants or tumor removal.

“Physical therapists have a role in helping these kids get back to speed,” said Ms. York, director of the Physical Therapy and Occupational Therapy Department and Early Intervention Program at Children’s Health System in Birmingham, Alabama.

Although some techniques used on children are similar to those for adults, there are differences between working with the age groups. Kids, for example, may be learning skills for the first time while adults are relearning what they already know.

The tools used also differ. Where adults may use basic exercise equipment and feel a sense of accomplishment in just finishing the task, children need to be engaged with toys and games and rewarded with small prizes or stickers. Children may also have behavior issues.

“Adults have motivation to work through an exercise. Even if it doesn’t feel so good, they understand the reason,” Ms. York noted. “Children don’t understand. They might cry.”

With kids, their families also need to be more involved. “A good portion of time is spent teaching families what to do and how to carry it out at home, educating the parents on what’s going on,” she added.

Ms. York, who has been a physical therapist for around 30 years, said many parents do whatever it takes to get their children the services they need, whether it’s obtaining therapy through EI, — which is offered to tots under 3 — private therapy or a combination of both. As they get older, therapies may also be provided in school.

During her son Jacob’s three-month well check-up, Joei Bradley of Arden Heights learned he had torticollis, a disorder that causes the neck to tilt to one side. Her pediatrician referred him to an EI program. Since Jacob’s condition was not considered severe and he didn’t have any other delays, he was not approved for services.

Mrs. Bradley was told it was likely Jacob would grow out of his left-leaning condition. However, she didn’t want to chance it.

“As a mom, I wanted to make sure I took care of it,” Mrs. Bradley said.

About a month ago, she began taking Jacob to see Dr. Kissel. The therapist works on stretching his neck muscles to both sides and uses toys to get him to move his neck to the left and right.

Prior to physical therapy, Mrs. Bradley would prop her son’s head up with a blanket to keep it from leaning left when he sat in his car seat. Now, when the five-month old sits up, his head is more aligned toward the center.

“I wouldn’t want him to be in a classroom with his head tilted to the left and kids asking him to move out of the way,” Mrs. Bradley said. “I wanted him to get the care he needs now.”